Levels and determinants of ambulatory mobility in lower-limb prosthesis users from urban and rural Cambodia: a cross-sectional survey study

Abstract

Objectives: The majority of people globally who have undergone limb amputations are living in low- and middle-income countries. For those with lower-limb amputations, ambulatory mobility with a prosthesis is considered a key factor for achieving independent living; however, little is known of determinants of mobility for prosthesis users in low- to middle-income countries. In this study, we sought to assess levels of self-reported mobility in Cambodian prosthesis users and to identify determinants associated with their ambulant mobility.

Design: Cross-sectional survey.

Setting: Three secondary care centres located in urban and rural Cambodia.

Participants: Adults receiving prosthetic services for a major lower-limb amputation.

Primary and secondary outcome measurements: The Khmer version of the LCI-5 and the mobility dimension of the EuroQol five-dimensional five levels (EQ-5D-5L) were used as dependent variables, while personal, physical, psychological and social determinants served as independent variables. Associations were assessed using hierarchical and ordinal regression analyses.

Results: 347 participants completed the survey. Determinants that were negatively associated with mobility outcomes were as follows: being female, having an amputation due to dysvascular complications, using an above-knee prosthesis and reporting higher levels of psychological distress. Social determinants did not appear to have any major association with mobility outcomes.

Conclusions: Findings highlight the multidimensional nature of mobility and suggest that future interventions may benefit from targeting female prosthesis users and those with diabetes or vascular disease. Mental health interventions addressing symptoms of anxiety and depression may also contribute to improved mobility outcomes. Social determinants explored in the study were not associated with significant changes in mobility scores. This may be due to high overall levels of mobility, a relatively homogenous group or failure to identify context-specific variables that impact on mobility outcomes.

Keywords: Amputation, Surgical; Gait; REHABILITATION MEDICINE.

Figure 1. Schematic diagram of determinants explored in this study. EQ-5D-5L, EuroQol five-dimensional five levels; LCI-5, Locomotor Capabilities Index 5; PTSD, post-traumatic stress disorder.